Cardiovascular disease and anticoagulation
Sue has worked on numerous projects in the clinical topics of cardiovascular disease and anticoagulation since embarking on a career in health economics in 2001.
She advised on the modelling of the long-term cost-effectiveness of blood pressure diagnosis which was published in the Lancet and formed part of the NICE hypertension guidelines. In collaboration with Oxford University, Sue has led the economic component on a number of studies on the diagnosis and management of hypertension in primary care, with an emphasis on self-monitoring, including the TASMINH, TASMIN2 & TASMIN-SR trials. More recently the TASMINH4 trial and the PROOF-BP study have had results published in The Lancet and Hypertension, and the OPTIMISE trial, which explored reducing antihypertension medication in the elderly was published in JAMA and Hypertension. Two global health studies, Global AF Reach which undertook research into atrial fibrillation (AF) in Sri Lanka, Brazil and China, and Treats-AF which investigated an educational intervention for anticoagulation therapy in AF patients in Thailand are both completed and being written up for publication.
Sue’s current projects in this clinical area include the MAPS-2 trial (metoclopramide to prevent pneumonia after stroke), ABBRUPT, which looks at treatment for new onset AF in acute care settings and a NIHR programme grant concerning an intervention for post-stroke fatigue.
Musculoskeletal disease
Sue leads the health economics portfolio of research conducted in collaboration with Primary Care researchers at Keele University on a wide variety of musculoskeletal disorders. Core areas of research concern stratified care, osteoarthritis (OA) and inflammatory conditions. This long-standing research partnership has led to a number of key publications, for example the INSTINCTS trial, published in the Lancet, is the largest trial undertaken of corticosteroid injection compared with night splints for the relatively common but painful problem of carpal tunnel syndrome, and the first study to include a health economics analysis of these interventions.
Whilst the work with Keele has traditionally focussed on trial based economic evaluation, Sue has ensured that more recent work also includes a decision model-based evaluation to explore longer-term cost-effectiveness. Two NIHR Programme Grants containing trial and model-based economic evaluations are ongoing, concerning the use of prognostic and diagnostic information for targeting treatment in shoulder pain (PANDA-S) and a pharmacist-led primary care intervention for opioid-treated persistent non-cancer pain (PROMPPT). Three NIHR-funded trials HTA are also in progress on knee-braces for knee OA (PROP-OA), an allopurinol-based treat-to-target protocol for recurrent gout (T2T) and a vocational advice service for return to work (WAVE).
A new Programme Grant, CAM-PAIN, will determine the longer-term outcomes of child/adolescent musculoskeletal pain in primary care by describing overall prognosis, identifying prognostic factors, and estimating health service costs of children/adolescents presenting with new musculoskeletal pain, using Clinical Practice Research Datalink (CPRD) data. Additional new studies in their set up phase are FORENSIC assessing the effectiveness of lumbar fusion in severe low back pain and IDEAL, which will evaluate the diagnosis and Early referral of patients with AxiaL Spondyloarthiritis.
Three Keele-funded PhDs (with co-supervision from Sue) have been completed successfully on optimal care for OA, absenteeism and presenteeism in back pain patients and the use of decision modelling in the assessment of cost-effectiveness of stratified care in musculoskeletal disease.
Respiratory disease
Sue leads the health economics research on the programme of respiratory disease work, primarily concerning chronic obstructive pulmonary disease (COPD), led by colleagues within the Institute.
There are two NIHR-funded trials in this area with one assessing an intervention to manage acute exacerbations in COPD (Predict & Prevent), and one concerning smoking cessation with electronic cigarettes in COPD (ECal). Previous work includes Breathewell, an NIHR-funded Global Health programme of work of case finding and management of COPD in Brazil, China, Georgia and North Macedonia, and health economics is an integral component of the research in all four countries, and the TARGET-COPD case finding trial containing a within-trial and beyond-trial economic evaluation. The clinical trial has been published in Lancet Respiratory Medicine and the model-based analysis, the first of its kind, was published in Thorax.
Air pollution and Net-Zero
Bringing together her expertise in respiratory and cardiovascular disease, Sue is a co-investigator on WM-Air, a cross-College collaboration with the College of Life and Environmental Sciences, which secured £5m in funding from the NERC Regional Impact from Science of the Environment (RISE) Programme. The West Midlands Air Quality Improvement Programme (WM-AIR) includes a health strand, and Sue has led the development of a health economics-based toolkit for use by local public health decision makers (AQ-LAT). This downloadable web-based toolkit provides local estimates of how effective air pollution mitigation strategies will be in terms of reduction in mortality and morbidity, quality of life and health care resource use and costs. Sue is also part of the WM-Net Zero project, funded by the Wellcome Trust. This builds on the AQ-LAT modelling and will explore the health impacts of Net Zero polices. She is also a co-investigator on two new Net Zero studies, looking at decarbonisation in General Practice (GPNET-0, Warwick University) and the GreenSurg Programme, a £2.5m NIHR Programme Grant looking at interventions to reduce the carbon footprint of surgery.
Liver disease
More recently, Sue has become involved in Birmingham-led NIHR HTA trials concerning liver cirrhosis. CALIBRE compares carvedilol with variceal band ligation for the primary prevention of variceal bleeding in liver cirrhosis, and REACT-AVB compares Early transjugular intrahepatic portosystemic stent-shunt (TIPSS) in acute variceal bleeding.